Provider Demographics
NPI:1669152187
Name:GOMEZ FLORES, LILIBETH
Entity type:Individual
Prefix:
First Name:LILIBETH
Middle Name:
Last Name:GOMEZ FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 SW 156TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1548
Mailing Address - Country:US
Mailing Address - Phone:786-587-3551
Mailing Address - Fax:
Practice Address - Street 1:12001 SW 128TH CT STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4666
Practice Address - Country:US
Practice Address - Phone:305-330-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN283211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice